HOPE Score for Survival After ECMO in Cardiac Arrest (Hypothermia ECLS)
Predicts survival to hospital discharge for patients undergoing ECPR (extracorporeal CPR) for refractory cardiac arrest including accidental hypothermia. Validated for both hypothermic and normothermic ECPR patients.
Score interpretation
Multiple unfavourable ECPR prognostic factors -- ECPR unlikely to be beneficial
→ Consider futility of ECPR; senior cardiologist/intensivist and ethics review; if K+ > 12 mmol/L: ECPR contraindicated (irreversible cell death); if normothermic unwitnessed PEA without bystander CPR: very low survival rate (< 5%); palliative approach or cessation of resuscitation efforts appropriate; family support; organ donation discussion per protocol if applicable; autopsy referral as appropriate.
Intermediate prognostic factors -- ECPR may be beneficial with careful patient selection
→ ECPR team activation; rapid risk-benefit assessment; K+ monitoring (repeat if initial sample uncertain); if hypothermic: do not declare death until warm (rewarm with ECMO to >= 35 degrees C before stopping); if normothermic: time to ECMO cannulation critical (target < 60 min from collapse); mobilise hybrid OR or cath lab; rapid percutaneous cannulation; target ECMO flow 2.5-3.0 L/min; post-ECMO care: targeted temperature management, coronary angiography if cardiac cause, neurological monitoring; document time of arrest, CPR quality, and HOPE score.
Favourable ECPR prognostic factors -- proceed with ECPR urgently
→ Immediate ECPR activation; hypothermia protocol: rewarming on ECMO (target 1 degree C per hour); K+ critical threshold: if K+ <= 8 mmol/L even with prolonged arrest -- proceed (Kverno and colleagues HOPE score data); witnessed VF/VT with bystander CPR: excellent candidate regardless of CPR duration; rapid cannulation target < 20 minutes; ECMO flow maintenance; PCI if coronary cause identified; full post-resuscitation care (TTM 32-36 degrees C for 24 hours in normothermic arrest); prognostication only at >= 72 hours post-rewarming; family communication with optimistic framing.
Interpretation bands for the HOPE Score. Apply clinical judgement and local guidance.
References
- Pasquier M et al. The HOPE score: a prediction model for survival after ECMO for refractory cardiac arrest in hypothermia. Resuscitation. 2018;126:58-64.
- Pellegrino V et al. Extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest. Intensive Care Med. 2022;48(4):504-507.
Related
Curated clinical cross-links plus same-class fallbacks.
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.